About the inquiry
In November 2018, the Australian Productivity Commission commenced an inquiry into the role of mental health in the Australian economy and the best ways to support and improve national mental wellbeing.
The inquiry will consider how mental illness can affect all aspects of a person's quality of life including physical health, social participation, education, employment and financial status.
It will look at how governments across Australia, employers, professional and community groups in healthcare, education, employment, social services, housing and justice can contribute to improving mental health for people of all ages and cultural backgrounds.
To assist the Commission in undertaking this inquiry, Professor Harvey Whiteford, a former Chair of the Queensland Mental Health and Drug Advisory Council and member of the National Mental Health Commission's Advisory Board, has been appointed as an Associate Commissioner.
Many of the areas of reform required to improve the mental health and wellbeing, and social and economic participation of the Australian people lie outside the health system.
To achieve good mental health and wellbeing; prevent and reduce the impact of mental illnesss, problematic alcohol and other drug use; and prevent suicide, a more balanced approach to investment across the health, social and human service systems is needed.
The draft report was released on 31 October 2019.
The five core reform areas within the draft report are:
- prevention and early intervention
- closing critical gaps in healthcare services
- investment in services beyond health
- getting people into work and helping them remain there
- care navigation, coordination, governance and funding.
Key issues and draft recommendations
What problems are we addressing
Key recommendations (not all)
Prevention and early intervention
- Low awareness of care and supports available for help
- Widespread stigma and cultural barriers to accessing mental healthcare – especially for less common conditions
- Early childhood educators and teachers observe development problems but lack skills to respond effectively or pathways to direct families to
- Countless school wellbeing programs, but what works?
- Many people who attempt suicide receive no follow-up care in the vital weeks after discharge
- Numerous suicide prevention trials, but what works?
- Incorporate social & emotional wellbeing checks into existing physical development checks for 0-3 year olds
- All schools assign a teacher to be their mental health and wellbeing leader
- Reduce stigma among health professionals
- Follow-up people after a suicide attempt
- Indigenous organisations empowered as preferred providers of local suicide prevention activities for Aboriginal and Torres Strait Islander people
Close critical gaps in healthcare services
- Treatment tacked onto systems designed around physical illness
- Too often, the views/preferences of consumers and their carers get ignored
- Services are often unconnected, lacking clear pathways and communication between healthcare providers
- Significant service gaps for some
- GPs – as gateways and gatekeepers – too often lack mental health knowledge
- Face-to-face psychological therapy consistent with treatment needs
- Specialised mental healthcare professionals in regional and remote areas
- Alternatives to hospital EDs for people in crisis or needing after-hours care
- Community bed-based services as alternative to acute inpatient services
- Child and adolescent mental healthcare services.
- Expand clinician-supported online treatment options
- Provision of acute and non-acute beds and ambulatory services that reflect regionally assessed needs
- Improve the ED experience & provide alternatives
- Mental health expertise as support to police and paramedics
- Provision of child and adolescent mental health beds separate to adults
- Navigation platform for mental health referral pathways
- Care coordinators for consumers with the most complex care needs.
- Expand mental health nurse workforce
- Rigorous evaluation of Better Access.
Improvements beyond the health system
- Numerous gateways by which people can present in need of mental healthcare, but few provide a pathway
- Psychosocial supports can be critical for social inclusion, but ongoing provision can be very tenuous
- Chronic under-investment in stable housing options, with 16 per cent of people with mental illness either homeless or living in overcrowded or substandard accommodation
- Too many people returning to hospital inpatient facilities and correctional facilities because of lack of stable housing in their community
- People facing involuntary treatment often lack legal representation.
- Governments to commit to no discharges from care into homelessness
- Additional supported housing places for people needing care on a regular basis
- Work toward meeting the gap in long term housing for people with mental illness who are persistently homeless
- Standards of care in correctional facilities to be equivalent to care in community
- Ensure culturally capable mental healthcare for Aboriginal and Torres Strait Islanders in correctional facilities.
Increasing attachment to education and work
- Educational adjustments in schools for psychological disabilities are a legal requirement but can be hard to access
- Teenagers and young adults who disengage from education or work have reduced wellbeing and income prospects
- Employment services are not adequately tailored to the circumstances and capabilities of job seekers with mental illness
- Psychological hazards have received inadequate attention in workplace health and safety
- Delays in treatment for people who have work-related mental illness significantly adds to the cost of mental illness for the individual, workplace and community.
- Effective outreach to disengaged school students
- Increase the appropriateness of job plans for those people with mental illness who are using employment services
- Amend model WHS laws to elevate the importance of psychological health and safety
- Provision of no-liability clinical treatment for mental health related workers compensation claims
Governance and funding
- The programs and measures that Governments choose to fund seems ad hoc, fragmented, uncoordinated, duplicative in some regions, creating poor incentives for providers in others
- Lack of national coordination and consistency on measures to achieve desired outcomes
- A lot of data is collected but little information is derived and used – this limits incentives for providers to improve their services; and inhibits use of data by consumers and carers to make decisions about treatment and support options
- What interventions are outcome-effective and cost-effective remains a mystery in many areas.
- Include consumers and carers in all mental health program development
- COAG to develop a new National Mental Health and Suicide Prevention Agreement that
- Establishes clear funding, data sharing and service delivery responsibilities
- Creates Regional Commissioning Authority governance arrangements (if adopted)
- Expedite National Strategic Framework for Aboriginal and Torres Strait Islander People’s Mental Health and Social and Emotional Wellbeing
- Determine targets for key outcomes, and set data collection, monitoring and evaluation arrangements consistent with targets.
Draft recommendation 23.3 concludes that structural reform is necessary.
It states that the federal, state and territory governments should work together to reform the architecture of Australia’s mental health system to clarify federal roles and responsibilities and incentivise governments to invest in services that best meet the needs of people with mental illness and their carers. There should be greater regional control and responsibility for mental health funding.
The Productivity Commission proposes two distinct models for the mental health system:
- the Renovate model, which embraces current efforts at cooperation between Primary Health Networks (PHNs) and Local Hospital Networks
- the Rebuild model, under which state and territory governments would establish Regional Commissioning Authorities (RCAs) that pool funds from all tiers of government and commission nearly all mental healthcare (RCAs would take over PHNs’ mental health commissioning responsibilities and also commission more acute mental healthcare) and psychosocial and carer supports (outside the NDIS) for people living within their catchment areas.